By Grateful Ogunjebe
When the midwife wheeled the baby out, and the newborn’s face was blue, Dr. Owoicho Ojile didn’t hesitate. Within minutes, the theatre team had cut the uterus, freed the infant from a cord tightly wrapped around its neck, and handed a wailing, pink baby to its shocked mother. “If she’d pushed the baby at home another hour, we wouldn’t be telling this story,” he said.
That operating theatre has been where expertise, blood products, and trained hands intersect, and where many Nigerian mothers’ stories still end differently than they would have at home.
A Country Still Losing Too Many Mothers
Nigeria’s maternal mortality ratio remains alarmingly high. According to the World Health Organization (WHO), the country’s maternal mortality ratio is approximately 1,047 per 100,000 live births.
Only around four in ten births in Nigeria occur in health facilities. Most deliveries still happen at home, often under the care of unskilled attendants or relatives.
Why Hospitals Matter: The Clinical Edge
- Skilled personnel and emergency obstetric care, including caesarean sections, blood transfusions, and management of postpartum haemorrhage.
- Immediate newborn resuscitation and neonatal monitoring for distress, jaundice, or low blood sugar.
- Infection control and sterile procedures that significantly reduce the risk of sepsis.
These advantages are not theoretical. A 2023 national analysis by Oyewole et al., published in BMC Women’s Health, found that Nigerian women who received optimal antenatal care were significantly more likely to deliver in health facilities — a factor closely linked to improved maternal and newborn survival outcomes.
Similarly, Ilesanmi et al. (2023) in BMC Public Health demonstrated that continuity of care within formal health facilities strongly predicts hospital delivery, underscoring how failure to reach a hospital remains a major driver of preventable maternal and newborn deaths in Nigeria.
Why Women Still Give Birth at Home
1. Financial Barriers
Out-of-pocket payments, transportation costs, and fear of unexpected hospital bills push many women toward home births or traditional birth attendants. Women in the poorest wealth quintile are more than three times as likely to deliver at home as those in the richest.
2. Cultural Tradition and Social Pressure
Family elders and social norms often frame home birth as a rite of passage. Pregnant women may have limited power to challenge these expectations.
3. Access and Quality Gaps
In rural areas, health facilities may be hours away. Even when facilities exist, reports of long waiting times, disrespectful treatment, and lack of equipment discourage use.
Expert voices
Nurse Akpa Ada Vera, who has attended many births, emphasizes that hospital deliveries provide a critical safety net. She advised that Hospital deliveries provide a plethora of advantages to both mothers and babies, which include but are not limited to;
° Proper management of complications and risks, the availability of trained professionals at hospital deliveries makes it possible to identify and manage any risks that would arise in the process of delivery.
- Ability to offer resuscitation in cases of exhaustion in the mother or asphyxia in the baby
iii. Proper management of the varying stages of labour and monitoring of babies to identify and rule out the presence of certain conditions like Jaundice, low blood sugar in babies born with macrosomia.
The TBA Paradox: Trusted but Limited
Traditional birth attendants remain trusted figures due to affordability and cultural familiarity. However, research shows they often lack the capacity to manage severe complications such as postpartum haemorrhage or infections, leading to dangerous delays in referral.
Voices from Experience
“Emergency care is better handled in a hospital,” says Mrs. Peace Ogabi, who delivered in an Air Force hospital and credits continuous monitoring for a smooth birth. By contrast, Joheobe Gift Alfred, a first-time mum, described pressure from in-laws to use a general (cheaper) hospital and the “nonchalant” attitude of staff that left her feeling unsafe. Those two testimonies — one of reassurance, one of frustration — reflect why policy and human factors matter as much as bricks and mortar.
Cases that prove the point
Dr. Owoicho shared three near-misses: a cord-around-the-neck requiring immediate C-section; a fetus in distress born after hours of labor with foul-smelling liquor; and a woman self-medicating who developed an infection that could have been catastrophic. In each case, swift hospital intervention changed the outcome. Those clinical vignettes are evidence, not anecdote.
What Needs to Change
Research and program experience suggest these levers increase facility births and reduce deaths:
- Subsidised or free antenatal and delivery care. Cost reduction increases uptake, but must be paired with quality improvements to build women’s trust in the service.
- Community outreach and respectful-care campaigns. Tackling disrespectful treatment and rebuilding trust with women and families is critical. Qualitative studies repeatedly show that perceived staff attitude drives choices as much as price.
- Targeted rural investments. In places with very low facility use, mobile clinics, maternity waiting homes, and reliable transport can bridge geographic gaps. National and state policies must prioritise these hotspots.
- TBA engagement, training, and clear referral pathways. Where TBAs remain central to communities, training them to recognise danger signs and to refer early can reduce delays to emergency care. Evidence suggests training alone isn’t enough unless referral systems and facilities are ready to receive patients.
These strategies are supported by a body of evidence from researchers, including Gabrysch and Campbell (BMC Pregnancy & Childbirth), Bohren et al. (PLOS Medicine), Campbell and Graham (The Lancet), and multiple WHO maternal health policy reviews.
Make Safe Birth the Default
Nigeria’s maternal mortality burden and the high proportion of home births are solvable problems — but only if interventions are joined up: reduce cost barriers, fix transport, invest in respectful, well-staffed facilities, and partner with communities. The operating theatre in Jos, where a baby was saved, is not a moral sermon — it’s a demonstration of what works when systems and people are ready.
As Dr. Owoicho put it: “We don’t want more stories where the only reason a mother dies is that someone thought she could give birth at home and save costs.” That simple sentence should be a policy plan.
